Network of doctors for multimorbidity and diabetes: Development of the NOMAD intervention - a multidisciplinary team for patients with diabetes and multimorbidity.

Abstract

Purpose: This article reports the development of the NOMAD intervention, a model of multidisciplinary team conferences designed to improve care coordination and treatment for patients with multimorbidity and diabetes. Managing multiple chronic conditions increases care complexity, and multidisciplinary approaches may enhance care coherence, optimise treatment, and improve quality of life.

Method: Guided by the Medical Research Council framework for developing complex interventions, we established a working group, formulated a programme theory, and conducted a preliminary test with qualitative interviews of patients and physicians. The intervention targets patients with diabetes and concurrent chronic conditions affecting the heart, lungs, or kidneys.

Results: The NOMAD intervention was developed as a structured model of regular, in-person multidisciplinary team conferences involving specialists in endocrinology, cardiology, respiratory medicine, nephrology, and pharmacology. A key component was the integration of patient-reported outcomes to enhance patient-centred care, highlighting the aspect of quality of life.

Conclusion: This development process provides a foundation for feasibility testing and future evaluation of NOMAD's impact in a randomised trial. Our experiences may also inform researchers and healthcare providers developing similar multidisciplinary interventions for complex patient populations.